Provider Demographics
NPI:1366849960
Name:TRIAD PRO HEALTH CHIROPRACTIC
Entity type:Organization
Organization Name:TRIAD PRO HEALTH CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRITZ
Authorized Official - Middle Name:G
Authorized Official - Last Name:MESILIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-401-5061
Mailing Address - Street 1:1802 MARTIN LUTHER KING PKWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3586
Mailing Address - Country:US
Mailing Address - Phone:919-401-5061
Mailing Address - Fax:919-401-8253
Practice Address - Street 1:1802 MARTIN LUTHER KING PARKWAY
Practice Address - Street 2:SUITE 107
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3586
Practice Address - Country:US
Practice Address - Phone:919-401-5061
Practice Address - Fax:919-401-8253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4491111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1073914511OtherNATIONAL PROVIDER NUMBER